Background: Urine 3-methyl histidine (3-MH) is generally used as a marker of muscular proteolysis. Although plasma 3-MH concentration can reflect proteolysis, there are few reports in humans and the normal range has not been determined. Methods: Plasma 3-MH was determined by high performance liquid chromatography in 101 healthy adults. Also, nutritional status in critically ill patients was evaluated by blood and urine 3-MH, which were compared with the normal ranges. Results: The normal range of plasma 3-MH was demonstrated as 0.91-5.59nmol⁄ml in healthy adults. It was significantly different between males and females (1.22-6.26vs.1.09-4.41nmol⁄ml, p<0.05). This difference was no longer significant after dividing plasma 3-MH with plasma creatinine (Cre) and the range became 0.13-0.53nmol⁄μg Cre. Plasma 3-MH⁄Cre in critically ill patients was significantly higher than that in the healthy adults (0.59±0.12vs. 0.33±0.10 nmol⁄μg Cre, p<0.05), possibly indicating degradation of muscular protein. There was no correlation between plasma 3-MH⁄Cre and albumin or rapid turn-over proteins. In conclusion, the normal ranges of plasma 3-MH and 3-MH⁄Cre were determined in healthy adults. Plasma 3-MH and 3-MH⁄Cre were higher in the critically ill patients.

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Coexistence of esophageal carcinoma and hepatocellular carcinoma is rare, and the prognosis has been reported to be unfavorable in such case. We encountered a case of advanced esophageal carcinoma complicated with multiple hepatocellular carcinomas. A 65-year-old male patient was referred to our hospital because of severe dysphagia in May 2006. He was diagnosed as having squamous cell carcinoma in the middle of the thoracic esophagus. Dynamic computed tomography (CT) and abdominal angiography detected two more tumors compatible with hepatocellular carcinoma in the segments 6 and 8 of the liver. After radiofrequency ablation (RFA) therapy against the liver tumors, subtotal esophagectomy was done, followed by biweekly chemotherapy with docetaxel against the residual esophageal carcinomas. At 4 months after the operation, abdominal CT detedted topical recurrence in the segment 8 of the liver. Additional RFA therapy was done. At 8 months after the initial operation, transhepatic arterial chemo-lipiodolization and RFA therapy were added against another topical recurrence in the same segment of the liver. He has no sign of recurrence at present. This case was presented with reviewing the literature.

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A 65-year-old woman was admitted to our hospital for melena and prolapse of the rectum. Blood tests revealed severe anemia. She often suffered severe protrusion of the rectum during and after defecation. Colonoscopy revealed swelling of the rectal mucosa, redness, and a polypoid elevation located 5-15 cm from the anal verge. Mucosal prolapse syndrome (MPS) was diagnosed on the basis of histological features of the endoscopically resected specimen and clinical findings. MPS of rectum is usually treated conservatively by educating the patient concerning bowel habits to avoid straining and by preventing constipation with laxatives. In this case, however, the rectal prolapse was severe. Thus, transabdominal proctopexy was performed. The postoperative course was uneventful. For the best results, MPS associated with complete rectal prolapse should be treated surgically.

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